Medicaid disconnect

[ValeRx]

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So I'm trying to figure out where the disconnect happens between Medicaid and the patient. I'm sure we've all seen or heard of the recent article where a family, who had been receiving Medicaid/Medicare benefits was living in a million dollar beach house. Then I see the patient angry because their Caresource card was rejected and we had to rebill under Advance PCS of Texas... and they almost had to pay cash for their non-life sustaining medication aka <insert ADHD med here>..... and they speed off in their Escalade/Lexus/various other $50,000+ gas guzzler vehicle.

Then you've got my little brother who was diagnosed with DM type 1 when he was 28 years old after going into DKA with no family history of DM. He can't afford to pay for his insulin because he gets no insurance through his part time job and lives in a small town trying to get his culinary degree and is denied for financial assistance.

So what gives? How are some individuals able to get their amphetamine Rx's and everything else for free, including OTC meds and drive expensive cars.. yet people actually in need are denied? Where's the disconnect?

 

[spacecowgirl]

He needs to have children

 

[007rx]

What sucks is it sounds like he's being a good citizen and paying taxes and going to school so he will have a good job and contribute to society by paying more taxes (which is what makes Medicaid go 'round), yet many people (not all) on Medicaid have no jobs, get welfare/unemployment, and have no intention of paying taxes or contributing to society. There is a huge disconnect in the system.

 

[Jackie B]

Usually welfare is the issue, given to refugees or other immigrants in the US. I'm in So Cal where there are a lot of immigrants from various ethnic groups. It seems like these individuals come here as refugees - in order to qualify to be a refugee I think you have to sell all your possessions in your foreign country, show that you don't have money etc etc but a lot of these individuals hide their money somewhere and once they get here have their relatives send it to them. Or they find jobs that are under the table but pay reasonably well so they don't claim it on their taxes. My friend works in ER admitting of a hospital in a town that has a lot of refugees and he says he gets really angry when they roll up in a BMW holding their LV purse and then hand over a medicare card when individuals who clearly live more modestly based on their dress and such get turned away b/c they don't have insurance.

I'm not sure who welfare is given to, I mean if you're poor you don't qualify for it? Maybe if your brother looked into it he can qualify for food stamps or some need-based insurance or something. I think a lot of Americans don't realize they're eligible or may be too embarrased to ask for help..

So I'm trying to figure out where the disconnect happens between Medicaid and the patient. I'm sure we've all seen or heard of the recent article where a family, who had been receiving Medicaid/Medicare benefits was living in a million dollar beach house. Then I see the patient angry because their Caresource card was rejected and we had to rebill under Advance PCS of Texas... and they almost had to pay cash for their non-life sustaining medication aka <insert ADHD med here>..... and they speed off in their Escalade/Lexus/various other $50,000+ gas guzzler vehicle.

Then you've got my little brother who was diagnosed with DM type 1 when he was 28 years old after going into DKA with no family history of DM. He can't afford to pay for his insulin because he gets no insurance through his part time job and lives in a small town trying to get his culinary degree and is denied for financial assistance.

So what gives? How are some individuals able to get their amphetamine Rx's and everything else for free, including OTC meds and drive expensive cars.. yet people actually in need are denied? Where's the disconnect?

 

[xiphoid2010]

So I'm trying to figure out where the disconnect happens between Medicaid and the patient. I'm sure we've all seen or heard of the recent article where a family, who had been receiving Medicaid/Medicare benefits was living in a million dollar beach house. Then I see the patient angry because their Caresource card was rejected and we had to rebill under Advance PCS of Texas... and they almost had to pay cash for their non-life sustaining medication aka <insert ADHD med here>..... and they speed off in their Escalade/Lexus/various other $50,000+ gas guzzler vehicle.

Then you've got my little brother who was diagnosed with DM type 1 when he was 28 years old after going into DKA with no family history of DM. He can't afford to pay for his insulin because he gets no insurance through his part time job and lives in a small town trying to get his culinary degree and is denied for financial assistance.

So what gives? How are some individuals able to get their amphetamine Rx's and everything else for free, including OTC meds and drive expensive cars.. yet people actually in need are denied? Where's the disconnect?

How you think they can afford all that bling, yo? They are selling something, probably including the meds they fooled someone into filling. Taxable income? What's that?

 

[ResCon]

My immediate suspicion is non-taxable source of income (drug dealer). That seems to be the case for some on Medical assistance who display no resemblance of a poverty stricken individual (e.g. expensive car, designer clothes, iPhone). IMO, there should be a hefty sentence enhancement for people who take advantage of public programs whilst retaining illegitimate sources of income (drug money).

 

[ValeRx]

I think the government needs to set up a new division of Medicare/Medicaid where investigators actually go out and audit recipients. I can guarantee the government would cut the deficit in half AFTER paying these auditors by the money they take back from non-deserving individuals abusing the system.